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“Selling drugs is a relationship business. It’s best to do it in person. That is why, on a summer evening in 2012, Alec Burlakoff was out for dinner with Steven Chun, the owner of Sarasota Pain Associates. Burlakoff was a sales manager for Insys Therapeutics, an Arizona-based pharmaceutical company with only one branded product, a new and highly potent opioid painkiller called Subsys. Chun was a doctor who prescribed a lot of opioids.

The location was a moderately expensive seafood restaurant in Sarasota, Fla., with linen tablecloths and large windows overlooking the bay. The sun was still high in the sky. Gleaming powerboats lined the docks outside, and a warm breeze rippled the water. On one side of the table were Burlakoff and Tracy Krane, an Insys sales representative. Krane was a newcomer to the industry, tall with dark brown hair in a bob. Burlakoff, then 38, with a slight frame and a boyish restlessness, was her new boss. He had years of experience in the opioid market. Colleagues marveled over his shameless push to make the sale, but he had a charisma that was hard to resist. Even people who didn’t trust him couldn’t help liking him.” . . .

“As a result of Insys’s approach to targeting doctors, its potent opioid was prescribed to patients it was never approved to treat — not occasionally, but tens of thousands of times. It is impossible to determine how many Subsys patients, under Kapoor, actually suffered from breakthrough cancer pain, but most estimates in court filings have put the number at roughly 20 percent. According to Iqvia data through September 2016, only 4 percent of all Subsys prescriptions were written by oncologists.

Jeff Buchalter, 34, a decorated Iraq war veteran, was one off-label Subsys patient. His doctor, William Tham, a paid Insys speaker, prescribed the drug to treat pain stemming from Buchalter’s wartime injuries, eventually raising the dose well beyond the maximum amount indicated by the F.D.A. Buchalter was taking it 12 times a day, not four to six, and alternating between the two highest doses, a medical chart from Tham’s clinic shows. Eventually, he had to be put under sedation in intensive care at Fort Belvoir, Va., while he went through withdrawal from Subsys and other prescription drugs. “I am frankly astonished at the amount of opioids the patient has been prescribed,” a hospital specialist noted in his records. Buchalter is suing Insys and Tham. (Tham’s lawyer, Andrew Vernick, told me, “He has done nothing wrong in this case, and he is not involved in any of the allegations that have been raised against Insys throughout the country.”)

Buchalter said Subsys gave him relief from pain, but it changed him into someone he did not recognize. He had always defined himself as a hard worker with integrity. With his eyes darting around the room as he spoke, he told me he became an addict, his day revolving around the next dose: He slept under his desk at the office, where boxes of Subsys filled the drawers, and his house went into foreclosure. Buchalter looked troubled and tired when we met. His hands were visibly dirty. “I’ve been absent from my life for years,” he told me. “What I remember is who I was when my daughter was born, and when I was a soldier.”

“SEVEN FORMER INSYS EXECUTIVES NOT ONLY FACE CRIMINAL PROSECUTION BUT STAND ACCUSED OF RACKETEERING UNDER THE RICO ACT, A LAW MORE COMMONLY INVOKED AGAINST ORGANIZED-CRIME FAMILIES AND DRUG GANGS. THE INDUSTRY WILL BE PAYING ATTENTION.”

DL: The head of Insys John Kapoor, and 6 other execs, are now arrested for bribes and racketeering.
My comment:
David Lindsay Jr. Hamden, CT Pending Approval
Great reporting by Evan Hughes, thank you. I pray that many of these criminals see many years in jail, or worse.
My son Austin Lindsay died of an opium overdose in August of 2011. He was brilliant but lazy young scholar, and petty drug dealer. His new love of opiates apparently came about because of his struggles with obesity. A “friend” stole a bottle of 100 opiate based tablets from a pharmacy, and gave them to my son, who found that they created a nausea that cut his appetite. He lost 70 or 100 pounds, and on the outside, he regained normalcy. But, apparently, he had a new craving, that didn’t go away as fast the the pounds that he had lost.
After reading this article, for the first time, it occurred to me to be possible that the pharmacy allowed bottles of opiates to be stolen. I’m probably just a bitter, heart-broken parent, but this story awakens a new set of questions.
David Lindsay Jr. is the author of “The Tay Son Rebellion, Historical Fiction of Eighteenth-century Vietnam,” and blogs at TheTaySonRebellion.com and InconvenientNews.wordpress.com, where his topics include The Drug Wars.

“CLEVELAND — Here are a few choice mutterings from the scrum of lawyers outside Courtroom 18B, about the federal judge who summoned them to a closed-door conference on hundreds of opioid lawsuits:“Grandstander.”

“Pollyanna.” “Over his head.”

And the chorus: “This is not how we do things!”

Judge Dan Aaron Polster of the Northern District of Ohio has perhaps the most daunting legal challenge in the country: resolving more than 400 federal lawsuits brought by cities, counties and Native American tribes against central figures in the national opioid tragedy, including makers of the prescription painkillers, companies that distribute them, and pharmacy chains that sell them. And he has made it clear that he will not be doing business as usual.

During the first hearing in the case, in early January, the judge informed lawyers that he intended to dispense with legal norms like discovery and would not preside over years of “unraveling complicated conspiracy theories.” Then he ordered them to prepare for settlement discussions immediately.Not a settlement that would be “just moving money around,” he added, but one that would provide meaningful solutions to a national crisis — by the end of this year.”

David Lindsay: I recommend the whole article above. This judge is amazing. He is using Organization Development theory and techniques, to bring the parties together, to share important information, and to work on collective problem solving. It’s brilliant, and he might get the parties in 400 federal lawsuites to work together.

“For decades, America has waged an ineffective war on drug pushers and drug lords, from Bronx street corners to Medellin, Colombia, regarding them as among the most contemptible specimens of humanity.One reason our efforts have failed is we ignored the biggest drug pushers of all: American pharmaceutical companies.

Our policy was: You get 15 people hooked on opioids, and you’re a thug who deserves to rot in hell; you get 150,000 people hooked, and you’re a marketing genius who deserves a huge bonus.

Big Pharma should be writhing in embarrassment this week after The Washington Post and “60 Minutes” reported that pharmaceutical lobbyists had manipulated Congress to hamstring the Drug Enforcement Administration. But the abuse goes far beyond that: The industry systematically manipulated the entire country for 25 years, and its executives are responsible for many of the 64,000 deaths of Americans last year from drugs — more than the number of Americans who died in the Vietnam and Iraq wars combined.

The opioid crisis unfolded because greedy people — Latin drug lords and American pharma executives alike — lost their humanity when they saw the astounding profits that could be made.”

Yes, thank you. Here is the leading comment, I support:

Meredith New York 16 hours ago

Kristof is blunt and true, but leaves out campaign donors.

It’s not only ‘greed’. Like our huge gun death rate isn’t only about rage or ‘mental illness’. It’s the opportunities our society offers to act out greed & sociopathy. Our election funding system supporting this.

In our political system, there are no limits to ‘monetization’.

Big pharma, like big gun makers are some of our biggest election sponsors, as we see the thousands of deaths pile up. With phony slogans of ‘freedom, and private profits unhindered by big govt’, we legitimize the world’s most profitable, exploitive industries in health, guns and elections.

Other capitalist democracies don’t prescribe paint killers at the US rate, have health care and medicine at lower cost. They limit gun possession.
They don’t turn over their elections to the biggest corporate megadonors,

See NYT past op ed by Richard Painter, chief WH ethics lawyer “The N.R.A. Protection Racket”. The racket applies to drugs, h/c and every issue, If politicians don’t play ball, their donors threaten to run somebody against them in a primary who will. Candidates know the rules.

Al Gore on CNN Zakaria show “ Our democracy has been hacked by big money long before Putin hacked our democracy.”

Do US voters know that Europe bans the drug ads direct to consumers that swamp our media, and bans privately paid campaign ads and also guns for all?

We need columns with contrasting positive examples along with moral outrage.

“Opioid addiction has developed such a powerful grip on Americans that some scientists have blamed it for lowering our life expectancy.

Drug overdoses, nearly two-thirds of them from prescription opioids, heroin and synthetic opioids, killed some 64,000 Americans last year, over 20 percent more than in 2015. That is also more than double the number in 2005, and nearly quadruple the number in 2000, when accidental falls killed more Americans than opioid overdoses.

The President’s Commission on Combating Drug Addiction and the Opioid Crisis said in July that its “first and most urgent recommendation” was for President Trump to declare a national emergency, to free up emergency funds for the crisis and “awaken every American to this simple fact: If this scourge has not found you or your family yet, without bold action by everyone, it soon will.” The commission’s final report is due out in a month.”

“It is possible to trace this devil’s dance back to the passage of the Civil Rights Act of 1964 and the emergence of Richard Nixon. After the passage of the act, the Republican Party, the party of Lincoln to which black people felt considerable fealty, turned on those people and stabbed them in the back.

In 1994 John Ehrlichman, Nixon’s domestic-policy adviser and a Watergate co-conspirator, confessed this to the author Dan Baum:“The Nixon campaign in 1968, and the Nixon White House after that, had two enemies: the antiwar left and black people. You understand what I’m saying? We knew we couldn’t make it illegal to be either against the war or blacks, but by getting the public to associate the hippies with marijuana and blacks with heroin, and then criminalizing both heavily, we could disrupt those communities. We could arrest their leaders, raid their homes, break up their meetings and vilify them night after night on the evening news. Did we know we were lying about the drugs? Of course we did.”

The era Ehrlichman referred to was the beginning of the War on Drugs. Nixon started his offensive in 1971, declaring in a speech from the White House Briefing Room: “America’s public enemy No. 1 in the United States is drug abuse. In order to fight and defeat this enemy, it is necessary to wage a new, all-out offensive.”The object of disrupting communities worked all too well — more than 40 million arrests have been conducted for drug-related offenses since 1971, with African-Americans being incarcerated in state prisons for these offenses at a rate that is 10 times greater than that for whites, according to Human Rights Watch.”

The above passages are of great interest to me. I suspected this, but never had an articulate confirmation before now. It is horrifying.

Here is a comment which I found helpful, and another quite amusing, if tragic.

ChristineMcM

“”This is the tragedy of racism because its ultimate logic is genocide. If one says that I am not good enough to live next door to him, if one says that I am not good enough to eat at a lunch counter, or to have a good, decent job, or to go to school with him merely because of my race, he is saying consciously or unconsciously that I do not deserve to exist.””

Charles, with this quote from King, you’ve opened my eyes to a shattering logic I could never reach on my own.

Your words are a blistering indictment of a party that pays lip service to equality but pursues bigotry via a return to harsh drug and voter “fraud” laws –the very policies Jeff Sessions is dragging back from the grave into our criminal justice system.

The other thing that astounds me in this piece is the how pernicious racism is even among the well-intentioned. The ultimate arrogance if you will–I feel your pain. Of course I can’t–I’m not in your shoes.

But by my vote I signal my beliefs. Never has this been truer than in the age of Trump, a man who managed to openly slander both Jews and African Americans in his justification of white supremacists and Neo-Nazis.

If you roll the videotape and watch the body language of Cohn, Menuchin, and Kelly, you need no other information on the size of the dagger Trump inserted into his presidency.

Is this the end of Trump, or only the first blow? Who knows–but your articulation of how racism works is irrefutable.

“About as many Americans are expected to die this year of drug overdoses as died in the Vietnam, Iraq and Afghanistan wars combined.For more than 100 years, death rates have been dropping for Americans — but now, because of opioids, death rates are rising again. We as a nation are going backward, and drug overdoses are now the leading cause of death for Americans under 50.

“There’s no question that there’s an epidemic and that this is a national public health emergency,” Dr. Leana Wen, the health commissioner of Baltimore, told me. “The number of people overdosing is skyrocketing, and we have no indication that we’ve reached the peak.”

Yet our efforts to address this scourge are pathetic.”

Yes. Here is one of many comments I support:
Mindy Ohio 5 hours ago
Sadly, there is still so much stigma surrounding the disease of addiction. Not one single person wakes up and each and every day and chooses to use. The brain is hijacked and rational decisions are impossible. We have ridden this roller coaster for many years. Our son, for today, in recovery, started in high school with OxyContin and then soon moved on to the cheap alternative, heroin. Our years of terror, fear and anger have morphed into compassion and rebuilding. But there are no guarantees. We have spent untold sums over the years, and are fortunate that we have not wiped our resources clean. Yet, even with the wherewithal to access good care, the system is overwhelmed. Treatment, i.e., evidenced-based therapies, medical-assisted-treatment (Suboxone etc.), is limited in availability because of overwhelming demand. Our son, who recently relapsed, was prescribed Suboxone and we called every pharmacy in the area to no avail.
The “Drug War” must end. We cannot arrest our way out of this crisis! As has been demonstrated in other countries, legalization works!! However, I fear, our Puritanical, judgmental, holier-than-thou white male-dominated lunatic right will continue to wag their fingers at these “losers.”

“LOS ANGELES — She was 4 years old when her aunt’s boyfriend began to abuse her sexually. Then at 14, she had a baby girl, the result of a gang rape.

Soon she fell under the control of a violent pimp and began cycling through jails, prisons, addiction and crime for more than 20 years.Yet today, Susan Burton is a national treasure. She leads a nonprofit helping people escape poverty and start over after prison, she’s a powerful advocate for providing drug treatment and ending mass incarceration — and her life story is testimony to the human capacity for resilience and recovery.”

” “Harm reduction” is an approach that was to some degree pioneered here. One of the nation’s first clean-needle exchanges started in nearby Tacoma in 1988.

King County is now considering opening what could be the country’s first safe-injection site. There, addicts could use drugs under supervision by a health worker who may, crucially, also open the door to recovery programs, all under one roof.”

These are tragic anecdotes, and horrifying statistics. Over 33,000 deaths to opiod addiction in the US in 2015. “The worst drug crisis in American history.”

I picked out the facts above, because they indicate the solution. Medicalize the problem. Make the addictive drugs legal or non-criminalized, and tens of thousands, perhaps millions, will be able to get professional help, while supplies will become less expensive and safer, and the obscene profits from the illegal trade will no longer destabilize politicians, courts and police and the young and old people who find illegal drug dealing irresistible.

My son Austin, before he died of a heroin overdose on August 5th, 2011, probably the first time he ever played with the drug, said more than once, “Dad, it is hard to stop dealing. I make so much money for so little work.” Austin, may he rest in peace, was addicted to the huge margins of the illegal drug trade. He quit a perfectly good job as a cook in a restaurant, and lied to his parents, saying he still worked there. He certainly had money to spend.

Though I might be an amateur economist, there are many famous economists who quietly support legalization. See the other posts in this blog. See the argument of Prohibition.

“MANCHESTER, N.H. — Chad Diaz began using heroin when he was 12. Now 36 and newly covered by Medicaid under the Affordable Care Act, he is on Suboxone, a substitute opioid that eases withdrawal symptoms and cravings, and he is slowly pulling himself together.

“This is the best my life has gone in many, many years,” Mr. Diaz, a big man wearing camouflage, said as he sat in a community health center here.

If Congress and President Trump succeed in dismantling the Affordable Care Act, he will have no insurance to pay for his medication or counseling, and he fears he will slide back to heroin.”

Milton Friedman (July 31, 1912 – November 16, 2006) was an American economist who received the 1976 Nobel Memorial Prize in Economic Sciences for his research on consumption analysis, monetary history and theory, and the complexity of stabilization policy.[4] With George Stigler and others, Friedman was among the intellectual leaders of the second generation of Chicago price theory, a methodological movement at the University of Chicago’s Department of Economics, Law School, and Graduate School of Business from the 1940s onward. Several students and young professors that were recruited or mentored by Friedman at Chicago went on to become leading economists; they include Gary Becker, Robert Fogel, Thomas Sowell[5] and Robert Lucas, Jr.[6]

. . . His books and essays have had an international influence, including in former communist states.[18][19][20][21] A survey of economists ranked Friedman as the second most popular economist of the twentieth century after John Maynard Keynes,[22] and The Economist described him as “the most influential economist of the second half of the 20th century … possibly of all of it.”[23]

Contents. . . 6.9 Drug policy

Drug policy

Friedman also supported libertarian policies such as legalization of drugs and prostitution. During 2005, Friedman and more than 500 other economists advocated discussions regarding the economic benefits of the legalization of marijuana.[78]